Provider Demographics
NPI:1114460318
Name:12 STEPS DRUG TREATMENT
Entity Type:Organization
Organization Name:12 STEPS DRUG TREATMENT
Other - Org Name:STEPHOUSE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILAGUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-394-3494
Mailing Address - Street 1:1927 HARBOR BLVD # 401
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7600
Mailing Address - Country:US
Mailing Address - Phone:714-394-3494
Mailing Address - Fax:
Practice Address - Street 1:1927 HARBOR BLVD # 401
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7600
Practice Address - Country:US
Practice Address - Phone:714-394-3494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHOUSE RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility